Sara did not expect much to come from her visit to the university’s counseling center, but she was concerned enough about the dark thoughts she’d been having that she decided to go anyway.

As she sat in the waiting room after turning in the patient questionnaire, she thought: “It’s probably not a big deal. I’m probably overreacting.”

But she wasn’t. After reviewing her screening survey, staff at the counseling center didn’t want her to leave without speaking to a therapist.

Like Sara – an actual student who agreed to let us share her story – half of all graduate students experience psychological distress. Four in 10 graduate students reported that mental or emotional health affected their academic performance in the previous four weeks. When asked about their mental health in the past year, 7 percent of graduate and professional students reported seriously considering suicide compared to 4 percent of adults in the general population.

As researchers who study mental health and mentor graduate students, we believe critical changes need to be made at universities to better support students like Sara. Some of these changes can be made by individual graduate students and faculty, while others require larger institutional changes by graduate programs, departments and the universities as a whole.

1. Fight the culture of silence

We believe the culture of silence surrounding mental health in academia needs to be changed into a “culture of access” around mental health. This involves starting with the assumption that graduate students with mental health concerns are expected and welcomed in academia, not aberrant cases that need to be dealt with.

2. Expect reluctance

Even as society struggles to normalize conversations about mental health, students may still find it difficult to reach out for help. As was the case for Sara, students may feel they aren’t in bad enough shape to need help. They may also worry about being judged by their community, may want to handle things on their own or may not have the time or money for services.

One way students can help each other is by reaching out to students who seem to be struggling. We personally know students who only sought care after a concerned peer reached out.

Some barriers, like stigma, may be particularly acute for certain groups. For example, a forthcoming article in the Journal of Adolescent Health found relatively modest variation in mental health problems among students of different races and ethnicities, but that students of color were much less likely to be diagnosed or to seek help. That study – by Sarah Lipson and colleagues – found that Asian and Asian-American students are particularly unlikely to seek and receive treatment.

Universities must make sure mental health care for all graduate students is accessible and affordable. Students can call on their universities to enact the specific recommendations put forth in the Equity in Mental Health framework.

Reducing harassment in academia will require institutional change. There are specific red flags that signal that institutional change is needed, and there are specific actions that individuals, graduate programs and universities can take to enact that change. These include being clear about what constitutes sexual harassment and having trainings that focus on changing behaviors, not beliefs.

4. Create peer support networks

Research indicates that support from co-workers helps academic staff members cope with work-related stress. Graduate students could benefit from peer support, such as writing groups run by trained peer facilitators. As one example, students at the University of Melbourne developed Write Smarter: Feel Better, a peer mentoring for Ph.D. students that focuses on productivity and mental health. Graduate students can create such groups and graduate programs can support peer facilitator training.

5. Reduce student stress and anxiety

Except in the case of relaxation training, short stress reduction courses of eight weeks were as effective as longer courses. This suggests that graduate students would benefit from seeking out such courses and that universities should implement them. The benefits of such courses could be realized in just half a semester.

6. Recognize that overwork comes at a cost

As one study put it, it’s normal in the world of science and academia to view the “ideal scientist” as one who “gives priority to work, has few outside interests or responsibilities, and pursues research single-mindedly.” High work demands are a major cause of poor graduate student mental health and work-family conflict was the strongest predictor of psychological distress in one recent study of Ph.D. students.

Work-related stress is associated with burnout and poor mental health, and excessive work demands drive overwork and poor work-life balance. Overwork can also reduce productivity, driving “presenteeism,” where people are present at work but not productive, as well as high levels of turnover and negative attitudes towards work.

Thus, graduate students, faculty, and staff must recognize that overwork comes at a substantial personal cost. A guide to creating supportive environments for academics with mental health conditions notes that we must “avoid supporting or valorizing behaviors that erode mental health, such as working extremely long hours, or making the job more important than anything else.”

7. Help graduate students who need to take leave

Some graduate students who face mental health issues will need to take medical leave. At present, departments and programs treat each individual case as a crisis that needs to be dealt with. But given the prevalence of mental health conditions in academia, it should be expected that such needs will arise regularly. For that reason, we believe consistent mechanisms to support students who take medical leave should be created.

Unfortunately, in many places, stipend support for students is removed if they take medical leave. This means that students might be financially unable to use medical leave to address their mental health. Graduate students should advocate for mechanisms to support students who need to take medical leave, and administrators should work on enacting those changes. Creating fellowships for students who need medical leave would help students get needed help.

In the end, Sara left academia and is thriving elsewhere. For her, academia wasn’t a healthy place. Perhaps if more programs adopted the strategies shared here, graduate school would be a healthier place for students like Sara, improving their experience and making it so that society does not lose out on their contributions.